What the Plan Does Not Cover

• Care specifically provided for detoxification of or rehabilitation for alcohol or drug abuse (chemical dependency), except drug abuse sustained at the hands of or while being treated by a Physician for an injury or sickness.
• Any service or supply received outside the United States or its territories.
• Illness, treatment or medical condition arising out of:
  • war or act of war (whether declared or undeclared)
  • participation in a felony, riot or insurrection
  • service in the armed forces or auxiliary units
  • attempted suicide (while sane or insane) or intentionally self-inflicted injury
  • aviation (this applies only to non-fare paying passengers).
• Treatment provided in a government facility, unless otherwise required by law.
• Any care provided while in a hospital, except for confinement in a distinct part of a hospital which is licensed as a nursing home or hospice.
• Any service provided by your immediate family, unless the service is a covered service from an informal caregiver.
• Any service or supply to the extent that such expenses are reimbursable under Medicare, or would be reimbursable but for the application of a deductible, coinsurance or copayment amount. This exclusion will not apply in those instances where Medicare is determined to be secondary payor under applicable law.
• Services for which no charge is normally made in the absence of insurance.

Concurrent Review

Changing Your Selections

Inflation Increases

Reinstatement